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. 2012 Sep 15;10:190.
doi: 10.1186/1477-7819-10-190.

Low Accuracy of Endoscopic Ultrasonography for Detailed T Staging in Gastric Cancer

Free PMC article

Low Accuracy of Endoscopic Ultrasonography for Detailed T Staging in Gastric Cancer

Han Hong Lee et al. World J Surg Oncol. .
Free PMC article


Background: The accuracy of endoscopic ultrasonography (EUS) for preoperative staging of gastric cancer varies. The aim of this study was to investigate the accuracy of EUS tumor (T) and node (N) staging, and to identify the histopathological factors influencing accuracy based on the detailed tumor depth of gastric cancer.

Methods: In total, 309 patients with gastric cancer with confirmed pathological staging underwent EUS examination for preoperative staging at Seoul St. Mary's Hospital, Korea, between January and December 2009. The T and N staging of EUS and the pathologic report were compared.

Results: The overall accuracies of EUS for T stage and the detailed T stages were 70.2% and 43.0%, respectively. In detailed stage, tumors greater than 50 mm in diameter were significantly associated with T overstaging (odds ratio (OR) = 2.094). The overall accuracy of EUS for N staging was 71.2%. Tumor size (20 mm ≤ size < 50 mm, OR = 4.389; and 50 mm ≤ size, OR = 8.170), cross-sectional tumor location (circumferential, OR = 4.381) and tumor depth (submucosa, OR = 3.324; muscular propria, OR = 6.923; sub-serosa, OR = 4.517; and serosa-exposed, OR = 6.495) were significant factors affecting incorrect nodal detection.

Conclusions: Careful attention is required during EUS examination of large-sized gastric cancers to increase accuracy, especially for T staging.


Figure 1
Figure 1
Endoscopic ultrasonography (EUS) (A) EUS showing normal layers of gastric wall, with the five-layered echo pattern being clearly visible (arrow). (B) EUS of early gastric cancer (T1a), showing a focal thickening area confined to layers 1 and 2(dotted line). (C) EUS image of advanced gastric cancer (T3); the tumor involves all layers and extends beyond the the outermost layer of the gastric wall (arrow). (D) EUS showing a metastatic lymph node (dotted line).
Figure 2
Figure 2
Treatment algorithm for gastric cancer based on the detailed tumor (T) stages. EUS, endoscopic ultrasonography; UL, ulceration.

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